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Functional and cognitive outcome in prolonged refractory status epilepticus.
Alex D Cooper1, Jeffrey W Britton, Alejandro A Rabinstein
1Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. alex.cooper@nwhsea.org
Archives of Neurology
|December 17, 2009
Summary
Patients with prolonged refractory status epilepticus (PRSE) face high mortality, but survivors can achieve meaningful functional and cognitive recovery. Duration alone should not halt treatment for this severe seizure condition.
Area of Science:
- Neurology
- Critical Care Medicine
- Epileptology
Background:
- Prolonged refractory status epilepticus (PRSE) is a severe neurological emergency requiring aggressive treatment.
- Anesthetic agents are typically used to suppress seizures in PRSE, but outcomes remain a concern.
Purpose of the Study:
- To evaluate the functional and cognitive outcomes for patients experiencing PRSE lasting seven days or longer.
- To assess survival rates and the quality of life post-treatment for PRSE patients.
Main Methods:
- A retrospective analysis was conducted at St. Mary's Hospital, Mayo Clinic.
- Fourteen patients diagnosed with PRSE were included, with data collected via hospital follow-up interviews.
- Outcomes were measured using the modified Rankin Scale (mRS) for functional status and the Telephone Interview for Cognitive Status (TICS) for cognition.
Main Results:
- The mortality rate during hospitalization for PRSE was 43% (6/14), with an overall mortality of 57% (8/14) by last follow-up.
- Among the six survivors, four demonstrated functional improvement (median mRS change -1), and five had cognitive scores within the normal range on TICS.
- No significant association was found between survival chance and PRSE duration, etiology, age, or sex.
Conclusions:
- Survival with significant functional and cognitive recovery is achievable in patients with PRSE, despite the high mortality risk.
- The duration of status epilepticus should not be the sole factor in deciding to discontinue treatment for PRSE.
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